On Public TV Patient No. 1 (And a Noninfectious Wet Kiss To the Italians)

Revere at Effect Measure undertakes to defend Public TB Case No. 1 (link):

According to him -- and he says he has it on tape -- he was told he wasn't a risk to anyone before he left. By all accounts this was, and probably still is, true (I will review the evidence in another post). He had no cough or fever or other symptoms (i.e., he has latent, not active TB at this time) and his sputum had no visible tubercle bacilli under the microscope. In other words, he is like 95% of people infected with this bug, not sick. Most are also not infectious. The diagnosis that he was potentially infectious must have come from culturing the sputum for the TB organism, which grows very slowly. It can take months, sometimes. Again, when it grew they probably tested it against the usual drugs and found it was resistant to the first line ones. At that point they likely started the culture growing again against the second line drugs. That takes more time, and he was in Europe before it was discovered it was resistant to those as well, i.e., that he had XDR-TB.

Okay so far. But:

It's at this point things start to unravel. Like most people infected with TB he isn't sick, but the TB can start up and cause active illness at any time. And active TB with XDR strains has a fairly high mortality, not because it is more virulent (it isn't), or more infectious (it isn't) but because TB is not a good disease and it can kill you. We don't fear it now in the US because we have drugs for it. Except, of course, if it is XDR.

So as I imagine the circumstance, here's a guy whose life suddenly turns in an instant. He gets a message from CDC he now has a life changing disease and his only shot at cure is in a hospital in Denver. But he is told he has to report to Italian authorities and stay in an Italian hospital for an undetermined, possibly indefinite, length of time, during which they may irreparably damage the chance of successful treatment by using an improper drug regimen. So he panics and heads for home. It is important to note this guy was not a fugitive. He wasn't running from anything. He was running to something (home, family and his chance to be cured). As soon as he reached US soil he turned himself in.

It’s an honorable effort, but it has some problems, which Revere himself seems tacitly to acknowledge. The first words are “according to him”—i.e., we’re asked to exonerate the defendant on defense testimony only. I wouldn’t take that one to the bank.

The second part seems to me more challenging. My first thought, watching the story on Jim Lehrer last night, was that the patient's conduct from Italy on was inexcusable. Revere makes a beguiling argument—but it’s not so much as a defense as an excuse, a plea for forgiveness.

As a judge, I’d give it a thought at sentencing phase, even if not on guilt. But let me offer a response. That is: if I had to pick a country whose hospital I might be stuck in, Italy might very well be my first choice. They may not be the most high-tech, but they are super diagnosticians, and they are fine at patient care. You may have to bribe the nurses for patient care, but you might eat well. I guess my only concern is that when the Italians decide you’re done, you’re done—none of this nonsense about “extraordinary means.”